Chapter 3: Working with your vulnerabilities

The importance of clear boundaries

The importance of clear boundaries

Boundaries are the physical and emotional limits that exist between you and your patients and families. Boundaries are essential because they establish and maintain a trusting, professional relationship and can help prevent compassion distress.  In determining and maintaining your personal boundaries, you will want to ensure you preserve a balance without being too rigid but also not too fluid.

If your boundaries are too rigid, you may come across as uncaring and detached.

If boundaries are too fluid, you may have difficulty separating yourself from the situation, which can interfere with your doing your job well.

Key boundaries in ICU

Below are some of the many examples you may encounter while working in ICU. Click on each example to read more.

Example #1 Patient is dying or has died

You may be inclined to be more lenient or accept certain behaviours, or to act in certain ways you otherwise might not (e.g., not setting limits with a family member who is verbally abusive or threatening).

Example #2 A close bond with the family

A deeper relationship between you and the family than is the norm may develop.

Example #3 Difficulty saying goodbye

Family members may have difficulty saying goodbye or may wish to continue to have a relationship with you after the death. You may even have similar feelings yourself and find yourself conflicted between the natural pull you feel towards the family and the boundaries your training prescribes.

Click on each item for more detail

You may feel uncomfortable about these feelings or the tension they create, and you may want to dismiss or minimize them. Find a way to set boundaries while respectfully acknowledging the intimacy, which is real and yet specific to the particular circumstances. 

Contemplations for Clinicians 

Am I behaving differently than I would in any other case?

If I'm going the extra mile for a patient or family, am I serving my interests of that of the family?

In the midst of intensity and time constraints in ICU, you may have little or no time to consider the finer points of professional boundaries.

The following questions may help guide you BEFORE you’re confronted with boundary issues in working with patients and families in the ICU: